Diagnosed with sleep apnea and confused ?

beyondtired · Post by **beyondtired** » Tue Feb 22, 2011 5:09 pm

Hello,
I suffer from symptoms of excessive daytime sleepiness, short term memory problems, brain fog, etc. I always wake up unrefreshed, no matter how long I sleep, and I'm exhausted throughout the whole day. This has been going on for several years. Back in 2004, I had a sleep test done, but they did not find that I had sleep apnea. I've had other types of treatments over the years including ones for thyroid, adrenal fatigue, etc., and nothing has helped me.

Recently, I had another overnight sleep study, and I was diagnosed with mild sleep apnea. Next week, I will be going back to the sleep lab to have an overnight study with CPAP. The sleep doctor told me that just cause my case of sleep apnea is mild, that doesn't mean that my symptoms would be. He said that he has had patients with mild sleep apnea that had severe symptoms(such as myself), and also has had patients with severe sleep apnea, that have had more mild symptoms. I've read on various sites where it said that CPAP isn't usually used for mild sleep apnea though? Since I'm a little underweight, losing weight isn't going to help. Have there been many people at this forum with mild sleep apnea that have benefitted from using CPAP?

I noticed in my current sleep test that I had a large amount of sleep in stage 1. I thought people usually don't spend a whole lot of time in stage 1 though? The real low amount of REM sleep during the PSG is abnormal for me too. I took some ambien before the sleep test. I usually only take sleeping pills every once in a great while. Ambien isn't supposed to alter the sleep stages or suppress REM sleep right? Each night at home, I usually have multiple dreams that I can remember, after waking up after each one. I can dream real quickly after falling asleep. I could get woken up a few minutes after falling asleep and remember dreaming. I even experience dream like images that pop into my head even before I'm asleep. I had an MSLT after the PSG. I was very anxious during the MSLT and only fell asleep during one of the naps, and I didn't have REM sleep during it. At home where I'm more comfortable, I know I could have fallen asleep during several of the naps. I know these types of things can be signs of Narcolepsy, and it makes me wonder if I might have that, or if the abnormal REM sleep signs are because of sleep deprivation from sleep apnea. I don't want to go into too much more detail about the REM sleep though, since I had already made a thread concerning it here:

viewtopic.php?f=1&t=60296

Since all the other treatments I've tried haven't helped, I'm not feeling as hopeful as I'd like to be, that CPAP can help my symptoms. Is there a chance that somehow I got a false positive result during the sleep test? Sorry for being so negative. Maybe some input can give me more of a positive direction. Here are the results of my recent sleep test:

Baseline SpO2 was 98.3 %
Total sleep time was 228.0 minutes.
Sleep efficiency was 54.2 %
Sleep latency was 17.5 minutes.
REM sleep latency was 13.5 minutes

N1 53.9 % 123.0 minutes
N2 40.8 % 93.0 minutes
N3 3.9 % 9.0 minutes
REM 1.3 % 3.0 minutes

Apnea Index = 0.0 events per hour of sleep
Hypopnea index = 12.9 events per hour of sleep
AHI = 12.9 events per hour of sleep
Supine AHI = 10.2 events per hour of sleep
REM related AHI = 0.0 events per hour of sleep
Nadir Sp02 = 90.0 %

Mild obstructive sleep apnea is present in addition to intermittent snore arousals. These caused a mild degree of sleep fragmentation and hypoxemia.

No significant PLMs are noted.

No significant cardiac arrhythmias were seen.

Diagnosis: Adult obstructive sleep apnea

SharonC · Post by **SharonC** » Tue Feb 22, 2011 5:23 pm

Beyond Tired,
I was diagnosed with mild sleep apnea and have been on APAP since August 2010...I am blessed to have adapted to CPAP like a duck to water...5 1/2 hours the first night, which I was pleased with. I was so tired during the day, always napping when I could, getting up twice during the night and snoring so my husband could hear me downstairs! That has all stopped...I don't even get up during the night now and very rarely nap. I can't say I am really energized at my age but it sure is better than it used to be. Persevere with CPAP...good things don't happen overnight!

Pugsy · Post by **Pugsy** » Tue Feb 22, 2011 5:30 pm

beyondtired wrote:Is there a chance that somehow I got a false positive result during the sleep test? S

Not much chance of it being a false positive. The data doesn't lie.

What stood out to me on the sleep study results was the number of supine events. Roughly 10 out of 12 per hour supine or on your back, do you normally spend most of the night on your back?
and the fact that you had very little sleep in N3 and REM. If I remember correctly N3 especially and REM is when most of our most restorative sleep occurs. The Ambien wouldn't cause that. It doesn't mess with the data that much. That is why it is often prescribed during sleep studies. If you aren't getting enough restorative sleep for any reason it is certainly going to drag you down.

You may seem to get to REM quickly when you sleep at home but then you say to wake up. Something is waking you up.... There is also a little thing called REM rebound that could be occurring. Google it to find lots of goodies to read.

Sounds to me like you are doubting needing CPAP.. Do the titration study. I was considered "mild" OSA due to 11 events /hr in non REM sleep. Once I got into REM and had some REM sleep, it went to 53 events per hour. Like you I had minimal sleep in REM during first study. I think it was about 18 minutes or so. So short they had to extrapolate the numbers.

At this point you really have nothing to lose and a lot to gain.

BlackSpinner · Post by **BlackSpinner** » Tue Feb 22, 2011 5:56 pm

Each night at home, I usually have multiple dreams that I can remember, after waking up after each one. I can dream real quickly after falling asleep.

That doesn't mean you reached REM sleep. One dreams a lot of the time during non REM sleep too and those are the ones you remember in the morning. REM sleep dreams are different and are related to memory retention. They tend to be more stressful dreams too.

kteague · Post by **kteague** » Tue Feb 22, 2011 7:03 pm

I'm guessing the sites you mentioned about not using CPAP for mild OSA were promoting other solutions. I think it would be more accurate to say that other solutions, like surgery or dental devices, are more likely to be a viable option for those with mild OSA than those more severe. When I first started on CPAP in 2005, My diagnosis was mild. Over the years I later tested moderate and moderate to severe. Since you got so little REM sleep in the study, it may be that what you exhibited during the study isn't a complete picture of your OSA. Consistent effective treatment of your OSA over a period of time may resolve your daytime sleepiness. I would not doubt the need for treatment - your symptoms are pretty classic so it's not like you got a surprise report with no correlating symptoms. Your doctor told you right about degree of severity may or may not be evidenced by symptoms. Unfortunately many who get a mild diagnosis mistake that for meaning there's no need to intervene. In what other health realm would we propose doing nothing - a mild case of cancer? a mild heart attack? a mild stroke? NO. We would take steps to prevent further injury or advancing of the condition. Look at treating your OSA as investment in your future, an opportunity to give your health one more advantage.

beyondtired · Post by **beyondtired** » Sun Feb 27, 2011 7:27 pm

Thanks everyone for the replies.

SharonC,
Thank you for your story. I am glad to hear that people have benefitted from using CPAP for mild sleep apnea and that you are doing better.

Pugsy,
I didn't think that I normally spent a lot of time sleeping on my back during the night. When I try to get to sleep, I know that I'm almost always on my side or stomach. Though, maybe I do move onto my back more during the night than I thought I did?

BlackSpinner,
A lot of the dreams that I remember seem to be pretty vivid dreams. I'll wake up different times each night after some of the dreams. I thought that most of the vivid types of dreams were during REM sleep? I do know that if I get woken up in the morning by my alarm clock, and I hit the snooze button, I'll dream during that 10 minutes until the alarm clock goes off again. And if I hit the snooze button once again, the process continues and I start dreaming. Even before I fall asleep each night, the dreams seem like they are starting.

kteague,
Some of the sites were general health topic related sites that mentioned how mild sleep apnea usually doesn't need to be treated with CPAP. I think one of them might have been Web MD. Though, that's true, you make a good point about trying not to get caught up in the sleep apnea diagnosis being labeled as 'mild'.

It's not that I don't think I need CPAP treatment. I'm sorry if it came off that way. I do hope that CPAP can help my symptoms improve, such as the excessive daytime sleepiness. It's just that I don't want to get my hopes up too much, cause then it would be even more of a letdown if it doesn't help. Like I had mentioned, I've had doctors tell me in that past that they thought they knew what was wrong with me based on lab tests, and that I would start to feel better with the type of treatment that I was given. Though, nothing ever made me feel better. So at this point I'm cautiously optimistic about CPAP.

I think it's odd that substances such as caffeine don't seem to have an effect on me? I can take one of those caffeine tablets, which is supposed to be equal to at least one cup of coffee or more, and fall asleep not long after taking it. The same thing happens with an energy drink. I've also been put on things in the past, such as Ritalin and Provigil, which didn't help my energy levels.

Also, is it abnormal for the symptoms of sleep apnea to first start real quickly? For example, my symptom of excessive daytime sleepiness literally seemed to start one morning right away, out of the blue. I would usually feel refreshed when I got at least 8 plus hours of sleep. But that morning it felt like I had hardly slept at all, even though I had a full night of sleep. The day before that I didn't have excessive daytime sleepiness. So the exhaustion wasn't a gradual thing, it happened real fast.

BlackSpinner · Post by **BlackSpinner** » Sun Feb 27, 2011 7:45 pm

beyondtired wrote: BlackSpinner,
A lot of the dreams that I remember seem to be pretty vivid dreams. I'll wake up different times each night after some of the dreams. I thought that most of the vivid types of dreams were during REM sleep? I do know that if I get woken up in the morning by my alarm clock, and I hit the snooze button, I'll dream during that 10 minutes until the alarm clock goes off again. And if I hit the snooze button once again, the process continues and I start dreaming. Even before I fall asleep each night, the dreams seem like they are starting.

Vivid has nothing to do with REM. You can have vivid and usually pleasant dreams outside REM. This site explains it really well.

Also, is it abnormal for the symptoms of sleep apnea to first start real quickly? For example, my symptom of excessive daytime sleepiness literally seemed to start one morning right away, out of the blue. I would usually feel refreshed when I got at least 8 plus hours of sleep. But that morning it felt like I had hardly slept at all, even though I had a full night of sleep. The day before that I didn't have excessive daytime sleepiness. So the exhaustion wasn't a gradual thing, it happened real fast.

Other then random high blood pressure and some anxiety I had no symptom until I got a bad flu - then it was as if I couldn't recover from it. It is like "the last straw" syndrome, everything is fine and then the whole thing collapses, one too many apnea, or O2 desat and your body throws in the towel.

Pugsy · Post by **Pugsy** » Sun Feb 27, 2011 8:24 pm

I only mentioned the supine events because most of your AHI occurred supine.
Sleep studies typically want a person on their back because events may be positional and it gives them sort of a worst case scenario. So I guess they recorded you on your back for a while.

beyondtired wrote: Apnea Index = 0.0 events per hour of sleep
Hypopnea index = 12.9 events per hour of sleep
AHI = 12.9 events per hour of sleep
Supine AHI = 10.2 events per hour of sleep

beyondtired · Post by **beyondtired** » Wed Mar 02, 2011 10:54 am

Well during the first night PSG, they told me I didn't have to stay on my back, and that I could move around as much as I wanted. When I go in for the titration, they will probably tell me to try to stay on my back right? Even if I wanted to move around some though, I guess it would be tough anyway with the mask on and everything?

I'm going to be heading to the sleep lab Thursday night for the second night sleep study, with titration. The next morning, I'm going to be meeting with a sleep doctor in the sleep lab to go over the results. If he gives me a prescription for CPAP, do you's have any suggestions about things that I should maybe say to the doctor? For example, I've read some posts where people said to ask for a copy of the CPAP prescription? And I should definitely look into an Auto PAP that is data capable? Anything else? Thanks.

robysue · Post by **robysue** » Wed Mar 02, 2011 11:03 am

beyondtired wrote:Well during the first night PSG, they told me I didn't have to stay on my back, and that I could move around as much as I wanted. When I go in for the titration, they will probably tell me to try to stay on my back right? Even if I wanted to move around some though, I guess it would be tough anyway with the mask on and everything?

During my three titration studies, I was only told to try to sleep on my back once. And when I told the tech that I never fall asleep on my back and it hurts my back if I lie on it too long, she didn't press me any further and I slept the whole night (as I usually do) on my sides. During both my diagnostic study and my first titration study, I did (naturally) turn onto my back for short periods very late in the night---about an hour before LIghts On time.

Moving around can be done with the hose and mask on. It's a bit awkward at first, but it's not that difficult and certainly not impossible.

I'm going to be heading to the sleep lab Thursday night for the second night sleep study, with titration. The next morning, I'm going to be meeting with a sleep doctor in the sleep lab to go over the results. If he gives me a prescription for CPAP, do you's have any suggestions about things that I should maybe say to the doctor? For example, I've read some posts where people said to ask for a copy of the CPAP prescription? And I should definitely look into an Auto PAP that is data capable? Anything else? Thanks.

Tell the doc you need to investigate your insurance and that you want to shop around for a DME. Don't just go with the one suggested by the doc.

Pugsy · Post by **Pugsy** » Wed Mar 02, 2011 11:05 am

One of the members here Jankintz has a wonderful blog that has tons of information for newbies.
http://maskarrayed.wordpress.com/
Take time to sort through her various topics especially the one about what you need to know before you meed the DME. It will clarify a lot of things for you.

Regarding the titration study. They may or may not encourage you to sleep on your back. Many do because of the worst case scenario but you can get on your side with all the attachments. I know I started on my side but ended up on my back for the short time I actually got any sleep during the titration study.

Mr Bill · Post by **Mr Bill** » Wed Mar 02, 2011 8:15 pm

BlackSpinner wrote:Other then random high blood pressure and some anxiety I had no symptom until I got a bad flu - then it was as if I couldn't recover from it. It is like "the last straw" syndrome, everything is fine and then the whole thing collapses, one too many apnea, or O2 desat and your body throws in the towel.

Wow this really resonates with me. I never knew I had a problem till I got a couple of kittens in Sept 2008. I sleep very light and let the sleep on my bed. They kept waking me up. Next thing I know I am really really sleep deprived and can't seem to recover. First I blame it on the cats, then my BP medication which my Dr changes. A visit to the neurologist for symptoms of numbness all over produces a prognosis of "get more exercise". But its a year later in July 2010 that it all crashes again and I realize something is actually wrong and get my first sleep lab in Sep 2010.

Mr Bill · Post by **Mr Bill** » Wed Mar 02, 2011 8:31 pm

Back on topic. During my first sleep study, he encouraged me to try to sleep on my side to reduce obstructive apnea so he could try to get me to sleep using CPAP and BIPAP. Neither one worked and we went on to sleep study number two. I'll second what others said about REM. My pulse oximetry seemed to indicate regular sleep punctuated with obstructive sleep apnea. Turned out the apparent normal sleep numbers were me nearly wide awake and the apnea was happening every time I started to slip into REM sleep. Result, confusion, memory loss, poor recall, forgetfulness, foggy thinking, high blood pressure, weight gain, and so so tired. If you are tired after sleeping, something is wrong. Hopefully the upcoming CPAP test will find it for you.

Cindy Lou Who · Post by **Cindy Lou Who** » Wed Mar 02, 2011 9:39 pm

beyondtired, Welcome to the board and good luck on your test!
It's very important to get a fully data capable machine and the software so you can see your data. There are a lot of great folks here that can help with questions and make suggestions to help you optimize your treatment.
Some times people have trouble finding a mask that works for them. Ask the DME if they have a 30-day return policy. If what you get doesn't work push the DME to let you try another. Getting the right mask is key to staying compliant and getting successful treatment.
"rooster" has a great list of questions to ask your sleep Dr. (See below.) And, by the way, you are very luck to be able to talk with that Dr so soon. I'm jealous

Questions to ask about your PSG and Titration Study
by CPAPtalk member rooster

1. Did I have any central apneas? How many?

2. Were there any comorbidities? What were they?

3. Did I breathe or leak through my mouth? How often? What do you recommend to prevent it?

3. Did I exhibit Positional Sleep Apnea (PSA)? Was my apnea more severe in one sleeping position as compared to others? Is my pressure requirement higher in one position as compared to others? (Often sleep apnea is more severe when sleeping on the back.)

4. Is there anything else unusual about the results?

5. How will I know my therapy is preventing apneas?

6. I am determined to own a data-capable machine and software to monitor apneas, hypopneas and mask leak. This will allow me to call your office with specific questions if I have problems with the therapy. Will you help me with the appropriate prescription?

In addition to the questions:

1. Get a copy of your PSG. It is your legal right to have one.

2. Get a copy of your CPAP prescription.

3. Make sure the prescription calls for a humidifier with the machine.

wiki/index.php/Sleep_study

Hope this all helps... Good Luck
Cindy

Diagnosed with sleep apnea and confused ?

Diagnosed with sleep apnea and confused ?

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